Parts of a prescription

1. Prescriber information: The doctor's name, address and phone number should

be clearly written (or pre-printed) on the top of the prescription form. Some states require
the doctor's state license number to be on the form. It is not recommended that you
preprint your Drug Enforcement Administration (DEA) number on the prescription pad. It
becomes too easy for drug abusers to lift a few prescription forms for illicit use if that
number is easily available. The DEA number is not required on noncontrolled
prescriptions; however, many pharmacies may request the DEA number with a
prescription to help when filing the patient's medication insurance claims.

For those who do not use their DEA number: Prescriptions are often counted by the DEA
number. If that number is not used on prescriptions written by optometrists, the count will
not reflect an accurate number of prescriptions coming from our profession. This will
affect the support optometry receives from pharmaceutical companies in terms of
service, educational program support and involvement in pharmaceutical clinical trials.

2. Patient information: This portion of the prescription should include at least the

first and last name of the patient and the age of the patient. Many names such as
"Smith" and "Jones" should include the complete name and address to help distinguish
patients with similar names. An address is required on schedule II controlled drugs and
should be included on prescriptions for any controlled substance. When the exact age is
unavailable the word "adult" may be used in the age slot. Children and the elderly may
need the weight listed when oral medications are prescribed.

3. Date prescribed: The date is part of the legal document confirming when the
prescription was written. Pharmacists are often presented prescriptions with dates that
are well past the prescribing date. Some patients elect to save prescriptions for future
use. This often includes antihistamines and antibiotics that may not be indicated or are
even dangerous for the patient's present condition.

4. Superscription: This is the Rx symbol on the prescription form that designates

the written document to be a prescription. Rx is an abbreviation for a Latin phrase that
means "take thou."

5. Inscription: An inscription includes the drug name, concentration and type of

preparation. Drug names should not be abbreviated and correct spelling is important to
assure that the correct medication is dispensed. Maxitrol (neomycin and polymyxin b
sulfates and dexamethasone, Alcon) and TobraDex (tobramycin and dexamethasone,
Alcon) are examples of drugs that are prepared in ointment (ung) or drop (gt) form.
Cortisporin (neomycin and polymyxin B sulfates, bacitracin zinc and hydrocortisone,
Glaxo Wellcome) comes in ophthalmic and otic (ear drops) preparations. Specify which
preparation you wish the patient to use.

Drug names can be written using the chemical name, such as ciprofloxacin 0.3%
(Ciloxan, Alcon) or the proprietary form that requests a specific brand name drug. This
 preparation is still under patent, so if you use either name the pharmacy will provide the
product manufactured by Alcon.

Tobramycin has recently come off patent. If you prescribe "Tobrex" the patient should
receive the drug manufactured by Alcon unless you check the box on the prescription
stating generics are acceptable. If you write "tobramycin," the patient will likely receive
the generic form of the drug.

Homatropine and pilocarpine come in different concentrations. It is good practice to

always specify the concentration, even if the drug comes in only one concentration. That
drug may come in other concentrations in the future. Concentration and preparation form
should be written just to the right of the drug name. Use the metric system of weights
and measures.

To avoid misinterpretation of the preparation strength, follow this standard in writing

percentages: If the percent is less than one, always precede the decimal with a zero,
such as 0.1% or 0.05%. If the percent is greater than one, with no fraction, do not use a
zero after the decimal, such as 1%. Writing 1.0% could easily be misread as 10%.

6. Subscription (Disp): Historically, this was an instruction to the pharmacist to

compound medications. This could include, for example, instructions regarding the
fortification of tobramycin for treating a corneal ulcer. Today, most medications are pre-
compounded preparations. Subscription now indicates the quantity of medication
(number of capsules or tablets) or the size of the bottle to be dispensed (5 mL, 10 mL,
15 mL).

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7. The doctor's instructions to the pharmacist (Signatura-Sig) These are the

doctor's instructions to the pharmacist indicating how the patient should use the
medication. They should be as specific as possible to ensure patient compliance and
proper use of medication. They consist of Latin or English abbreviations are used to
 provide specific instructions translated by the pharmacist for patient use. Typical
instructions on the prescription would follow in this order:

o 2 gtt q2h OD for 3 days These instructions as used on a prescription for

Ciloxan would be interpreted as follows: two drops every 2 hours instilled in the right eye
for 3 days.
o 1 tab po BID for 14 days These instructions as used on a prescription for
doxycycline would be interpreted as follows: one tablet by mouth two times per day for
14 days.
o 1 gt QID OU for 7 days, then BID for 14 days, for itchy eyes
SHAKE These instructions as used on a prescription for Livostin (levocabastineHCl,
Ciba Vision Ophthalmics) would be interpreted as follows: one drop of Livostin four times
per day in each eye for 7 days and then decreased to two times per day for 14 days, for
itchy eyes caused by allergies; shake drops before use.
These instructions should be as specific as possible. Poor instructions given in the office
and on the prescription lead to poor compliance and often improper use of the
medication. It is appropriate to write what the medication is being prescribed for in the
signatura to let the patient know the indications for the medication. Phrases such as "for
eye pain" or "for itchy eyes" will help ensure that the medication is used appropriately.

8. Refill data: Provide the number of refills the patient should need to complete the
cycle of drug treatment. Most antibiotic and steroid prescriptions need no refills or one
refill. Glaucoma medications usually have three refills, which allows the patient enough
medication for 3 to 6 months, depending on the size of the bottles dispensed. Schedule
II controlled substances have no refills. Schedule III through V controlled substances can
have five refills or can be refilled for a maximum of 6 months, whichever comes first. In
eye care there is seldom a reason to have more than one refill on these controlled drugs.

9. Substitution permitted: Marking "Yes" allows the pharmacist to substitute a

generic form of the medication prescribed. Some health plans request that the generic
drug be used to save money. When writing the drug names remember that generic
names are not capitalized and brand names are capitalized: Pred Forte (Allergan) or
prednisolone acetate 1%.

10. Signature: Your signature and degree finalize the legal document. A signature
stamp can be used for noncontrolled substances. Prescriptions for controlled drugs
require a handwritten signature and DEA number.

Points to remember

 Keep good records of medications prescribed, dates written, length of treatment,

concentration of medication and your diagnosis of the condition.
 Explain specifically to the patient how to use the medication and why it should be
used.
 When possible, explain dosage, diagnosis and the reason for the treatment to the
available care giver of the patient (spouse, parent, child, friend, nurse).
 Give written instructions to the patient in the office when the dosage schedule is
complicated. When multiple medications are prescribed and tapering of dosage is
needed, written instructions are especially important to achieve compliance.
 Illiteracy is the forgotten reason for noncompliance. If you suspect the patient
cannot read or may not be able to understand written instructions, check for
understanding by having the patient repeat the instructions verbally after you have
explained how to use the medication. If possible, explain the dosage and treatment plan
to a family member.
A prescription written precisely and completely finalizes the plan for improvement of the
health and welfare of your patient's eyes. Learning the system for writing prescriptions
requires actually writing them and reviewing the above guidelines to be sure the
instructions and format are correct.

Use your resources to assure accuracy. When unsure, check your drug reference
literature on how to write a prescription, especially for an infrequently used medication.
Your pharmacist is a valuable source of information; don't be intimidated by calling and
asking his or her opinion.